What is thrombosed external hemorrhoid

A hemorrhoid is caused by increased pressure on the veins in your rectum. Some possible triggers include:. Once you have a hemorrhoid, it is possible for it to become thrombosed. Healthcare providers don't know why some people develop blood clots in their hemorrhoids and others don't. A thrombosed hemorrhoid usually appears as a small lump on the outside of your anus. The blood clot inside will make it appear dark and bluish in color.

A thrombosed hemorrhoid looks different than other hemorrhoids. An external hemorrhoid that is not thrombosed will just look like a rubbery lump without the blue color. Symptoms of thrombosed hemorrhoids include:. The pain will be at its worst for the first 24 to 48 hours. After that time, the blood clot will be slowly reabsorbed. When this happens, the pain will start to go away. If over-the-counter topical hemorrhoid medications don't relieve your pain, you may have a thrombosed hemorrhoid.

This is because the pain is not on the surface. Instead, it comes from pressure and swelling within the tissue. If you have a fever with a thrombosed hemorrhoid, see a healthcare provider. The hemorrhoid may be infected, which can cause a perianal abscess. This is a painful pocket of pus that forms in the top tissue layer around your anus.

Look for a boil-like lump that may be red and feel warm. See a healthcare provider if you suspect a perianal abscess.

It should be drained as soon as possible. An untreated perianal abscess can lead to an anal fistula. This is an abnormal connection between the skin and the anus.

A fistula may require surgery to correct. Never ignore rectal bleeding or assume that it is related to hemorrhoids. It could be a sign of something serious, like anal cancer or colorectal cancer.

See your healthcare provider if you have rectal bleeding. Most thrombosed hemorrhoids will get better on their own. It may take two to three weeks for them to disappear completely. In the meantime, there are options for self-care. In extreme cases, you may want to consider surgery.

Where this is not the case, there are some medical treatments available. Rarely, a person may require surgery with general anesthetic.

Treatments for hemorrhoids are usually effective. If a person experiences recurrent hemorrhoids, it is essential that they discuss this with their doctor. This article lists the best high-fiber foods to eat and which foods to avoid, as well as additional tips for the treatment and prevention of…. It is not always possible to tell the difference between cancer and hemorrhoids.

In most cases, a doctor will need to perform a full diagnosis. A perianal hematoma is a collection of blood that has leaked from a burst blood vessel in the area around the anus. It can cause discomfort but is…. When a thrombosed hemorrhoid fills up with too much blood, it can burst.

Learn more about the symptoms and how to treat a burst hemorrhoid here. Pregnant women are at a higher risk of developing hemorrhoids. Learn about the symptoms, causes, prevention, and the treatment options available. You can place new gauze over the wound, if you desire, whenever the gauze becomes soiled. Even with soft stools, some tearing of the stitches at the surgical site may occur during the first few weeks after the procedure.

If you have heavy bleeding, contact your doctor. Infection is uncommon after this procedure. However, you can apply antibiotic ointment to the site daily during the first week after your surgery. Call your doctor if the site develops redness, foul-smelling drainage or swelling, or if you have increasing discomfort in the area.

Twenty-minute sitz baths soaking in a tub of warm water can be taken during the first few weeks after the procedure to aid in healing and to provide comfort at the site. After 1 week, some people prefer to use medicines such as Anusol or Preparation H to soothe the tissues. It is very important that your bowel movements remain soft after surgery. Drink at least 6 full glasses of water daily. Take over-the-counter nonprescription stool softeners such as Colace or Surfak 2 capsules 2 times a day for at least the first 2 weeks after the procedure.

Take a stool-bulking agent such as Metamucil or Citrucel every day. These products can initially produce gas and bloating but can be easier to tolerate if the stool softeners are used simultaneously at the start 1 tablespoon daily in a large glass of orange juice, then slowly increase the amount according to package directions.

Straining at stool should be avoided after hemorrhoid treatments. Do not sit for long periods on the toilet. Remove all reading materials from the bathroom. Do not place anything in the rectum, such as an enema, for 3 weeks after the procedure.

Your doctor may want to examine your colon for coexisting disease. The procedure is called flexible sigmoidoscopy, and it may be performed 6 to 12 weeks after your hemorrhoid procedure.

You will be given more information if this is scheduled. Already a member or subscriber? External hemorrhoids often develop in healthy young persons and may suddenly become thrombosed. The thrombosis is slowly absorbed by the body during the course of several weeks.

A resolving thrombosis may erode through the skin and produce bleeding or drainage. Acutely swollen and tender thrombosed external hemorrhoids can be surgically removed during the first 72 hours after onset. After 72 hours, the discomfort of the procedure often exceeds the relief provided by the surgery.

Some patients still chose to undergo late surgery, although they should understand that without surgery the hemorrhoid will eventually become fibrosed and resolve over a period of days to weeks. An elliptic incision can be made over the thrombosis, and the clot and the entire diseased hemorrhoidal plexus can be removed in one piece. Although the site can be left open, many physicians prefer to place subcutaneous sutures to limit postoperative pain and bleeding.

Suturing in this area, historically, has been avoided because of fear of complications, yet the rich vascular network in the anal tissues usually provides for rapid healing. Simple incision over a thrombus after the administration of local anesthesia can be performed to remove the clot, but this procedure has been associated with a significant rate of rethrombosis.

Many experts now recommend excision of the entire thrombosis and the external hemorrhoidal vessels beneath. This procedure is more extensive than simple incision but usually yields a better outcome. The patient should be undressed from the waist down and draped.

An absorbent pad is placed beneath the patient. The patient can be seated on the examination table to speak with the physician. At the start of the procedure, the patient is rolled to the left side in the left lateral decubitus position. The right hip and knee are flexed, and a drape covers the patient's waist and legs. Place the following items on a nonsterile drape covering a Mayo stand: Nonsterile gloves.

The patient is placed in the left lateral decubitus position. The perianal skin is visualized by having an assistant separate the buttocks or by taping the buttocks apart. The anal canal can be visualized using an Ive's anoscope coated with 2 percent lidocaine jelly. The extent of the hemorrhoidal disease should be assessed and coexisting anal pathology excluded before initiating the procedure. Alternately, anoscopy can be performed after anesthetic administration injection when the thrombosed hemorrhoids are exquisitely tender.

The perianal skin and anal canal are cleansed with povidone-iodine solution. Avoid making multiple needle sticks in the anal tissues because the puncture sites can bleed after needle removal. Warn the patient about impending needle insertion into the tender tissues. A fusiform elliptic excision is made into the anal skin overlying the thrombosis.

It is preferable to make a radial incision extending out from the anal canal if the entire hemorrhoid plexus is removed; some physicians prefer a circumferential incision that exposes more clots by crossing over more of the hem orrhoidal sinusoids beneath Figure 1. Vigorous bleeding may accompany this incision and can be controlled with direct pressure or electrocautery if needed.

The circumferential incision of a thrombosed external hemorrhoid opens across the hemorrhoidal plexus, making removal of clots from the vessel easier. A clamp can be placed on the fusiform skin island and traction applied to the skin to reveal the hemorrhoid below Figure 2. The entire hemorrhoid is sharply excised with a no. The entire hemorrhoidal plexus usually can be removed as one piece attached to the fusiform skin island.

Avoid cutting into the muscle sphincter below the hemorrhoidal vessels. The fusiform island of skin is grasped and elevated.